| NPI | 1962854737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: WV 31201) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: IL 036149860) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.028502) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2025-08-04 |